Varicose Veins and Venous Insufficiency
A Cosmetic Problem Linked to a Larger Circulatory Problem
Aug 9, 2008
Varicose veins are surface veins that become dilated and visible under the skin, usually on the leg. Individuals with such veins may initially consider methods to eliminate them for cosmetic improvement. In many cases, however, varicose veins are the result of an underlying problem with the larger deeper veins.
Anatomy and Pathophysiology
The leg contains both superficial and deep veins. The superficial veins drain blood from the skin into the deep veins known as the greater saphenous vein and the short saphenous vein (formerly called the lesser saphenous vein). Blood from the deep veins travels further away from the leg and ultimately reaches the heart.
Veins normally have one-way valves that prevent the backflow of blood. If any of these valves are incompetent and allow some backflow (venous insufficiency), blood can build up in the veins (venous hypertension) and not move forward (venous stasis). This in turn can cause another valve to become incompetent. Ultimately, this leads to blood backing up and accumulating in the smaller superficial veins, thereby causing varicose veins. Varicose veins can also result from obstruction of blood flow through the legs.
Among the causes of varicose veins, two are notably common. One is deep vein thrombosis (DVT), the presence of a clot in the deep veins in the leg, obstructing blood flow through the leg. The other is pregnancy, which causes varicose veins by several mechanisms: weakness of the vein wall and valve by progesterone, a greater volume of blood circulating during pregnancy, and compression of the inferior vena cava by the uterus that causes increased blood pressure in the leg veins. Other causes of varicose veins include trauma and congenital malformations in the veins and/or valves.
Diagnosis
Patients with varicose veins may focus mainly on their unsightly appearance over the leg. It is still possible to have symptoms secondary to venous hypertension, including pain, soreness, cramping, and other types of discomfort in the leg. For further evaluation, visual and auditory Doppler ultrasound techniques can assess venous flow and detect a DVT as the cause of varicose veins.
Treatment
The treatment of varicose veins and venous insufficiency is mainly surgical. Open surgery techniques include saphenectomy to remove the greater or short saphenous vein, and phlebectomy to remove portions of smaller veins. Another method is to obliterate the space within a dilated vein. This can be done with an endovenous laser, radiofrequency ablation catheter, or injection of chemicals (sclerotherapy). After any treatment, the patient wears tight compression stockings to maintain pressure and flow within the veins.
